Provider Demographics
NPI:1720195043
Name:BERGER, FREDLYN SUE (OT)
Entity Type:Individual
Prefix:
First Name:FREDLYN
Middle Name:SUE
Last Name:BERGER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 LAUREL CANYON BLVD
Mailing Address - Street 2:SUITE # 600
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1559
Mailing Address - Country:US
Mailing Address - Phone:818-760-0501
Mailing Address - Fax:818-763-3890
Practice Address - Street 1:6400 LAUREL CANYON BLVD
Practice Address - Street 2:SUITE # 400
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1559
Practice Address - Country:US
Practice Address - Phone:818-763-0136
Practice Address - Fax:818-763-3838
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT1781225XP0200X
CA1781225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT1781OtherCA LICENE